Intrapulmonary shunt confirmed by intracardiac echocardiography in the diagnosis of hepatopulmonary syndrome.

H epatopulmonary syndrome (HPS) occurs in the setting of liver disease when oxygenation is impaired as a result of intrapulmonary vascular dilatation. The exact mechanism is not entirely clear, but is felt to be related to increases in pulmonary vasodilators, such as nitric oxide. Diagnosis requires the presence of liver disease, inadequate oxygenation, and confirmation of intrapulmonary shunting, generally by contrast-enhanced echocardiography. Occasionally, it can be difficult to decipher between intracardiac and intrapulmonary shunting. We report on a case of a male with cirrhosis who required the use of an intracardiac echocardiogram (ICE) for diagnosis of HPS.